Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Tuesday, November 20, 2012

The Patient Experience of EHRs

I'm often asked if the use of EHRs diminish clinician-patient interactions in the exam room.

At BIDMC, Jan Walker and Tom Delbanco have done focus groups with patients about technology. Generally, they found that patients will embrace technology that gives them access to information about their care. At BIDMC, where we have both a patient portal and Wi-Fi throughout the hospital, doctors often arrive at the bedside to find a patient viewing lab results on an iPad, ready with questions about their tests.

The literature studying outpatient offices with computers in the exam room suggest computers do not get in the way as long as clinicians are facile with them and maintain eye contact with patients.

Here are three articles:

"The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits." J Am Med Inform Assoc. 2005;12:474–480. DOI 10.1197/jamia.M1741.

"Studies examining physician EHR use have found mostly neutral or positive effects on patient satisfaction, but primary care researchers need to conduct further research for a more definitive answer." J Am Board Fam Med 2009;22:553–562.

"With the implementation of the electronic medical record—called HealthConnect—in all exam rooms throughout the Kaiser Permanente health care delivery system, how computers in the exam room affects physician-patient communication is a new concern. Patient satisfaction scores were obtained for all primary and specialty care physicians in a large medical center in Southern California to determine how scores changed as physicians started using HealthConnect in the exam room. Results show no significant changes in patient satisfaction for these physicians. Although concerns were not realized that patient satisfaction might decrease after HealthConnect was introduced, there was also no evidence that introducing an electronic medical record in outpatient clinics increased patient satisfaction." The Permanente Journal / Spring 2007/ Volume 11 No. 2

Clinicians have different approaches to the use of technology in the exam room - iPads, typing into a laptop, or just taking notes then entering data outside of the exam room. When clinicians and patients work together to ensure safe, accurate, and timely record keeping, everyone wins. Certainly, there may be awkwardness when clinicians struggle with new technology and patients perceive a change in attentiveness. However, it is highly likely that as clinicians spend their entire practice lives using EHRs and all patient records are recorded in EHRs, that this awkwardness will disappear. Just as mobile devices have replaced newspapers and magazines as the favored way for adults to access media, the EHR and PHR, as well as the processes needed to use them, will become a standard part of every clinical encounter, supporting rather than detracting from the patient experience.

My GP uses voice recognition to dictate notes during our encounter. I hear what he is saying, and even have a chance to question, augment or correct his entries. It works for me, and he reports that it makes his documentation process much more eficient.